• Lawrence Grierson, Ilana Allice, X Catherine Tong, Yu-Hin SiuHenryHDepartment of Family Medicine, McMaster University, Hamilton, Canada., Margo Mountjoy, Michelle Howard, Jesse Guscott, Alexandra Farag, Alison Baker, and Meredith Vanstone.
• Department of Family Medicine.
• Fam Med. 2022 Jun 1; 54 (6): 431-437.

Background And ObjectivesThe College of Family of Physicians of Canada's Certificates of Added Competence (CACs) denote enhanced-skill family physicians who function beyond the scope of family practice or in specialized areas fundamental to family medicine practice. The credential provides recognition for skill development in areas of need and is intended to augment comprehensive care; however, there are concerns that it increases focused practice and decreases commitment to generalist care. To inform credentialing policies, we elucidated physician and trainee motivations for pursuing the CAC credential.MethodsWe conducted secondary analyses of interview data collected during a multiple case study of the impacts of the CACs in Canada. We collected data from six cases, sampled to reflect variability in geography, patient population, and practice arrangement. The 48 participants included CAC holders, enhanced-skill family physicians, generalist family physicians, residents, specialists, and administrative staff. We subjected data to qualitative descriptive analysis, beginning with inductive code generation, and concluding in unconstrained deduction.ResultsFamily physicians and trainees pursue the credential to meet community health care needs, limit or promote diversity in practice, secure perceived professional benefits, and/or validate their sense of expertise. Notably, family physicians face barriers to engaging in enhanced skill training once their practice is established.ConclusionsWhile the CACs can enhance community-adaptive comprehensive care, they can also incentivize migration away from generalist practice. Credentialing policies should support enhanced skill designations that respond directly to pervasive community needs.

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